The right to health for people who use drugs | Karen Mamo

The World Drug Report of 2021 explains that despite a coordinated international approach to address drug use in society, the number of drug users increased by 22% between 2010 and 2019, with poor countries carrying the heaviest burden in health and social related matters.

Interestingly, almost ten years before, the United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (UNSR Health) presented a strong report denouncing current drug policies as constituting a direct infringement to the Right to Health for People Who Use Drugs.

Explaining that the concept of a drug-free world has failed, the UNSR Health identified criminalisation and excessive law enforcement as key perpetrators of stigma and acting as direct barriers to the realisation of the Right to Health. The UNSR Health also emphasized that the Right to Health should be guaranteed for all, irrespective if using drugs for recreational purposes or if experiencing dependence.

This research project looked at the Right to Health for PWUD and explored how discourse adopted by the United Nations General Assembly (UNGA) and civil society in the format of Transnational Advocacy Networks (TANs) has been protecting or hindering this right. The UN General Assembly is one of the most significant meetings in multilateral diplomacy as it gathers 193 member states to discuss various political, health, social and environmental matters. The official UNGA position stretching between the years 1998 and 2021 was contrasted with that of TANs shadow reports analysing the effects of the war on drugs and the role of international policy between the years 2009 and 2021.

Through a Critical Discourse Analysis framework based on the four-stage model developed by Norman Fairclough (2012), this qualitative research project distinguished texts as important barometers for social change.

Operating within historical and socially structured orders of discourse, agents transpose their ideological positions in text, and through semiotic difference construe reality, strengthen the status quo or challenge hegemony. The conscious inculcation of new discourse and therefore the use of rhetoric deployment to the dialectical process of operationalising discourse is directly linked to the technologisation of discourse and social change.

This study highlighted that the role of diplomatic consensus to adhere to a threat-based language and persistence to adopt international policies contributing to the creation of ‘unintended consequences’, continue to stall human rights developments for all PWUD. Following an increased number of countries introducing different levels of decriminalised systems for drugs, or legal regulatory frameworks for the non-medical use of cannabis, yet still blowing the prohibition trumpet at the UN, one questions the strengths of the Vienna consensus on drug policy and implications for the future.

Employed as a double-edged sword by actors representing the interests of competing ideological and commercial groups, diplomatic consensus is strategically being employed to maintain the status quo at international level, and promote the UN family’s vision of eliminating narcotic and psychotropic substances. The drug free societies mantra has throughout the years changed intonation, yet it continues to reverberate morally positioned beliefs on human behaviour, and the use of mind-altering substances. This dystopic approach is directly inflicting devastating losses for all member states whilst further increasing health and social disparities across the north-south divide.

Most strikingly, the International Community continues to apply meagre human rights provisions when discussing drug policy, health and social justice matters. The ideology driven approach to pursue supply and demand reduction measures adopted by consensus at the expense of diplomatic squabbles or the risk of a diplomatic incidence for the inclusion of specific human rights terminology, such as Harm Reduction, continues to dominate the International Community’s discourse and vision.

In part, at a policy level, and from a North perspective, the UN Drug Control Conventions allow for flexible interpretation, so much so that certain countries have now moved to regulating the non-medical use of cannabis. This ever-increasing individual policy by UN member states, and therefore options leaning closer towards a human rights-based approach, are indicative of a recontextualisation of discourse at the regional and individual member state level. Nonetheless, work by TANs to push forward a global decriminalised system prioritising health and human rights over a threat-based approach has not been effective enough to translate into an updated UNGA human rights-based consensus on cooperation to address and counter the world drug (diplomatic) problem.

The research work disclosed in this publication is partially funded by the Endeavour Scholarship Scheme (Malta). Project part-financed by the European Social Fund – Operational Programme II – European Structural and Investment Funds 2014-2020 “Investing in human capital to create more opportunities and promote the well-being of society.”